Report of GPC England meeting 16 May 2019

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

16 May 2018

The GPC met this week. This was a GPC England meeting.

I was not terribly happy with this meeting.  Though the Speaker managed our time well and kept us on track, I did not feel that we were given enough opportunity to discuss matters.  Many items were essentially “receive” items with a small opportunity to ask questions (and no chance to respond to answers).  We also spent more time on a presentation by Dr Masood Nazir of NHSE on IT aspirations and plans than we did on the executive and policy leads’ reports.  My own feeling is that should be the other way round.  On the upside though, for the first time we have been asked for feedback, almost in the style of evaluation forms after a CPD activity.  I have done so.  At considerable length.

With regard to the Independent Enquiry that the BMA has organised after the sexism/misogyny scandal, it does appear that it will be properly independent, which provides some hope.  It should be starting soon, with a plan to report back in only a few months time.

New intercollegiate Safeguarding guidance has been released and as is often the case is onerous and far too time consuming for the reality of life.  As things stand, we will be spending more time on safeguarding training and reviews/reflection than we will on PCNs...

Honoraria issues continue to grumble along.  The Meldrum reforms which changed how things work with regard to resourcing your representation have not, in my view, been helpful.  for example, I attended the LMC conference in Belfast on your behalf (rather than as an LMC rep).  I did not receive any honorarium for either of the two days I attended.  I was able to claim for a locum cost on the Tuesday.  Wednesday is my day off so I was there in my own time.  However, I was fortunate that I am a partner in a practice.  If I had been a locum, I could not have claimed any money for the Tuesday to offset earnings lost by attending.  BMA rules don’t pay any honorarium until 12 meetings in a year have been attended.  This is partly because employed members (such as consultants) are entitled to up to 12 days of trade union time.  GPs, often being self-employed, are not able to make use of this of course.  For GPC reps, the GPDF pays an honorarium for attendance at GPC meetings.  For some reason, that has not been continued for LMC Conference, which to my mind is ridiculous.  If you want decent representation, you need to resource it.  It’s not a gravy train but if I can’t fund a locum (or afford to take the hit myself) I can’t go and represent you.  I also have considerable concern that the arrangements as they stand run the risk of reducing an appropriate diversity of representation: we might end up with a larger than appropriate number or ratio of straight, white, male, semi-retired people on the committee.  Oh, wait... (I only conform to some of those categories.) In my view, the only people who can decide whether a person or body represents them is the group of people concerned.  I *think* I do a decent job of representing all of you, but please keep the feedback coming.

Anyway, moving on from my own bugbears...

EMIS Amazon Web Services is a work in progress, with EMIS intending to move patient data on to AWS.  This is something which we support for reasons of service resilience, delivery and sustainability.  There is much work ongoing to tie down the details of any Data Controller liability issues.  Practices in due course will need to update their Privacy Notices and inform their patients about changes, which will involve things such as automated text messages and emailing.  EMIS will be writing to practices at the appropriate time.  One for your radar rather than any action at the moment.

There is a review of the GP trainee contract arrangements as part of wider junior doctors’ contract negotiations.  This is currently confidential but I understand there will be more Comms very soon from the relevant committees and subcommittees of the BMA.

As I mentioned above, Dr Nazir presented on IT aspirations and plans from NHSE.  While interesting, I feel it would have been better to have that item away from the main committee meeting.  

We briefly discussed PCNs, negotiations on the details of the staff groups from year two are beginning and the support that has been put in place this year for ACDs will continue, as there is a recognition that ACDs may well change often.

There was an oral update from Dr Zoe Norris, the outgoing sessional subcommittee chair, who is also leaving the GPC.  She has been remarkable in her vigour and tenacity in her relatively brief time on the committee, representing sessionals’ interests consistently and comprehensively.  She leaves a legacy of a much more visible part of our profession, one which has historically been somewhat neglected by the GPC and BMA.  I will not be alone in missing her contributions.

There were other items in the exec team’s report that were not discussed.  A version of that report will be provided by the GPC secretariat soon (usually the Monday after the meeting) and I will ask the LMC office to forward it on when it is available.

The next meeting is Thursday 18 July, another GPC England meeting.  After that, we have GPCUK in September.  You may recall there are fewer meetings now.  I am still unsure whether this is a good thing or not, to be honest and have suggested this is reviewed as I am concerned about the adequacy of representation at a national level.  But now I’m at risk of repeating myself.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

GPC report 17 January 2019

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

17 January 2019

The GPCE met today in London.  

It was a full day, with the majority of the time being taken up by discussions around a proposed contract deal.  Details of that are currently confidential but there will be an announcement in the next couple of weeks.  Many elements such as indemnity changes, if not details, have already been announced and I hope the package as a whole will become clear to you all soon.  The GPC will share this as soon as possible and there will be a series of contract roadshows in forthcoming months.

There were also two question and answer sessions.  

The first was with Nigel Watson, regarding his reported GP Partnership Review, which was published on 8 January and can be found here.    I think this is a good piece of work with much to commend in its pages.  However, delivery of the recommendations is a concern, given previous actions by DHSC.  That said, if the Secretary of State accepts any or all of them, the DHSC will have to find some way to implement them. There are also a number if YouTube videos on the different sections of the report:

• Summary of the review here
• Introduction Vblog here
• Workforce part 1 here
• Workforce part 2 here
• Risk here

Dovetailing nicely with that session, Nikki Kanani and Dominic Hardy of NHSE visited GPC to discuss the 10 year Long Term Plan which was recently announced.  Details of that can be found here, with a links to the full document, an on line version and a summary document.  The summary is worth looking at for all my constituents, being only a couple of pages long.

There seems to be a welcome meeting of minds and, to a degree, vision between NHSE and GPC.  Relationships this year have been more productive than of late.  There seems to be much more recognition of the vital importance of Primary care, and general practice within that, than before.  There is also a commitment to support and develop our part of the NHS after a drought of any real investment in the last decade.

The next event is the annual LMC Conference in Belfast on 19-20 March, which I shall be attending in my GPC capacity, with GPC UK meeting the following day.  The next GPC England meeting is in May.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 

Dr Russell Brown

GPC report for 15 Nov 2018

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

15 November 2018

The GPC met this week.  It was my second meeting this year after a period of absence from work for family reasons.  I am back in the saddle now and all is well.  

There was much time spent on Contract negotiations which are proceeding and I hope to be able to report more soon.  Suffice to say that there is much uncertainty as to long term planning in the NHS as a whole.

There was a lively debate about future ways of working, including Primary Care Networks and Integrated Care Systems, the latest buzz-phrases but towards which we are all moving.  My own feeling is that, essentially, this is the product the NHS wishes to purchase from us and so we should engage with LMCs central in the process so that we can help GPs develop matters to the benefit of patients.  As sure as eggs is eggs, if we leave it to others, they’ll muck it up and damage us in the process.  The fact that the benefits are nebulous and currently have no supporting evidence of benefit whatsoever seems to be an irrelevancy. For what it’s worth, we keep pointing this out, but apparently it will all be wonderful in the new systems.  Who knows?

There was an extensive update from the executive team and policy leads and I will ask the LMC office to attach those documents to this report.  GPC News is 4 pages long.  The Exec and Policy lead document is 14 but is worth at least a skim read to find info that may be relevant to you personally.

The next meeting is Friday 23 November, the LMC England Conference in London, which I shall be attending in my GPC capacity.  After that, we have GPC England in January and GPC UK in March.  You may recall there are fewer meetings now.  I am still unsure whether this is a good thing or not, to be honest.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

GPC report 15 March 2018

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 March 2018

Since my last report in January I am delighted to report you have re-elected me for another three years. I was unopposed, so no actual election took place.  That either means you are in the main happy with how I represent you or that you don't think there's anyone else you'd rather represent you. At least, that's the two options I prefer to consider. Nevertheless, I take the representative role seriously and so would encourage anyone interested to speak to me or Julius about either the GPC visitor scheme or other routes to election. And of course in three years, if you think you could do the job, I would encourage you to stand.

The GPC met on Thursday in Edinburgh.  This was a GPCUK meeting but the day began with an extraordinary GPC England meeting to discuss the progress of contract negotiations. I have delayed my report until details were published.  These can now be found via the Bma website.

Update from the exec team and policy leads:
In the same new format as January, we were provided with a written update from the executive team and policy leads.  A slightly edited version will be published early next week for LMCs. I will ask the LMC office to forward it on when it is released.  It is fairly long but provides much more information that such reports did previously. I find it very helpful but please feedback if you have any comments on it.

Dr Bawa-Garba and the GMC: there have been several meeting between the BMA (led by the Junior Doctors' Committee) and the GMC.  The GMC have made several pledges which can be found on the BMA website here.

Model locum T&Cs are being developed to assist both locums and practices in avoiding and resolving any problems and will provide equal protection for both parties.

We received updates from Wales, Scotland and Northern Ireland.  The situations are very different but just as challenging as in England. The Secretary of State wishes to undertake a Partnership model review, and the BMA will be one of the main contributors.

GDPR  
The Information commissioners in all four counties are working on final guidance.  The GPC will shortly be publishing adaptable templates for practices' policy posters.  I understand that GPs will be able to act as Data Processing Officers.

Following on from the themed debate at LMC Conference in Liverpool the week before, GPC discussed the Workload recommendations.  Hubs are still a popular model but are not without their issues.  Given the shortage of GPs generally and the often skeleton staff employed out of hours, it is difficult to see where clinicians manning the hubs are going to be found. Additionally, all these pathways of care are often confusing enough for us, never mind our patients.  As I may have mentioned before, we need demand management as otherwise workload management is going to fail. Compared to elsewhere in Europe, we see patients far more often per year for similar health outcomes.

We also had policy group meetings in the afternoon, essentially the old subcommittee meetings. In the Working at Scale Policy group that I work in, we discussed the STP agenda and our concerns with it as well as discussing pharmacists, allied professionals and the difficulty of making a success of things when agendas of different parties fail to mesh.

Separately to GPC I have been working within the BMA on a work stream called "Living our values", a response to some historical concerns about the way in which relationships within the BMA are managed.  In particular, trying to assist committee members to see that their behaviour may cause difficulties for others, given that there are often unconscious biases which may disadvantage certain groups such as women. This is a work in progress.  I am hoping it will lead to better, more inclusive and representatives policies within the Association.

The next GPC meeting is in May, a GPC England meeting being held in London.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 
Dr Russell Brown

GPC report 16 November 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16 November 2017

The GPC met on Thursday.  This was my first meeting for some time, having missed the last one for family reasons. GPC meets less frequently now, a fact I am still not convinced is sensible.  This time was a GPC England meeting, held at BMA House in London.

Much of the subject matter is confidential but hopefully only until Monday when the official GPC News comes out.  My plan (and you will be able to judge how effective it has been) is to send this report out with the official news. That way you'll get my impressions and the official bits side by side.

Negotiations for 2018/19: 
Negotiations are progressing but are currently strictly confidential.  As previously, this annual round of agreements is not going to solve the problems we face.  We were given much detail to allow us to decide whether to approve of the executive team's direction of travel. Broadly, we do.  More details when I am allowed to.

Update from the exec team and policy leads:
In a new format, we were provided with a written update from the executive team and policy leads.    This is confidential until Monday but is going to form the basis of the official GPC News.  There has been much work (as always) and I hope the new format will be more informative.  Suffice to say here that Julius and I are on different policy groups which we think will be complimentary to each other for Surrey and Sussex.  The subcommittees no longer meet, much of the work is undertaken electronically.  Whether this will continue I don't know but from a workflow point of view it seems to be working. That said, many of us feel disconnected from the work, with the lack of face to face meetings making discussion perhaps less productive. Nevertheless, I understand there will soon be policy group specific pages on the BMA website, if you feel the need to see how the work is divvied up.
Letter to Simon Stevens: Richard Vautrey has written to Mr Stevens to highlight the continuing farce that is Primary Care Support provided (using the word loosely) by Capita. Did I spell that correctly? Yes, good.  There are multiple issues which I suspect will be included in GPC news. Mr Stevens recent speech was both unprecedented and welcome in its criticism of NHS funding.
Practice closures: There has been much work by the BMA Comms team resulting in much media coverage.
Indemnity: there has been a high level meeting with various stakeholders to try and thrash out requirements going forward. It is recognised by DH that something must be done and soon. More meetings are planned.

As I think the policy area reports will be in GPC news, I won't cover them here but may comment depending on what ends up being published. Questions from you are as ever welcomed.

Saving General Practice
Following the publication at LMC Conference of the document of the above name, we discussed next steps. If you haven't seen it, it is available on the BMA website here. Comments welcome.

Scotland contract update
Although an England meeting, we were treated to a 45 minute update on the Scotland contract negotiations, details of which are on the BMA website. It was interesting but given the differences between the NHS in the two countries I am not sure some or indeed much of it could be applied in England. It seemed to me to be a step closer to a salaried service, albeit that it was emphasised that the independent contractor model was being promoted.

Accountable care models
We received and briefly discussed the BMA response to a consultation about proposed changes to the regulations to allow their development. The consultation was actually quite limited in scope but taking into account the views of various branch of practice committees including GPC the response was focussed and constructively critical. In particular the point was made that service integration does not actually require a new contractual model.  Again. The BMA response can be found at here.

LMC England Conference
As usual, a paper had been prepared for GPC outlining the motions passed and what effect these have on workflows and policy. Of course, most of us where there anyway as voting members of LMCs.... The BMA has published news from Conference here. There is also a webcast if you missed Conference and want to watch some or all of it. Yes, I know, but I felt I should tell you it's there. You know, in case you have a spare few hours.

NHS England review of urgent care
A large document entitled "Integrated Urgent Care Service Specification" was provided to us. It is only 148 pages if you fancy going to look for it. As ever with NHS England work of this nature, it makes enormous assumptions about General practice and it won't work without huge investment of resources, which ain't going to happen. Plus ça change.

The next GPC meeting is in January, a GPCUK meeting being held in Edinburgh.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful. 

GPC report 15 June 2017

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

15 June 2017

The GPC met today.  This was a GPC England meeting, the last of the current Bma year, with the Annual Representatives meeting later this month. Our current chair of GPC, Chaand Nagpaul, will be moving to take up the position of BMA Chair of Council.  This means that both GPCE and GPCUK will need new chair electing in July at the next GPCUK meeting.  At the moment I am unable to tell you who the candidates actually are as they can't technically throw their hats into the ring until nearer the time.  I have a couple of ideas who might though. I suspect we will end up with at least one new member of the executive team.

Much of the subject matter today is confidential but as usual I will tell you what I can. For a change I am going to try writing my report in real time, during the meeting.  Apologies in advance for any spelling or grammatical errors.

Chairman's report

Chaand gave a summary of events during his tenure, in particular the changes from last year and in particular the success of not allowing changes to our core hours. He also outlined the difficulties we are facing.  Quality First has been a success, with an emphasis on supporting Gps in resisting inappropriate demands on their time.

Indemnity

With recent changes in the law about the discount rate applied to compensation awards, it is likely that there will be a significant change in MDO subscription costs for GPs. Discussions regarding solutions are ongoing with the MDOs and representatives of the Department of Health who are well aware of the potentially destabilising and even catastrophic effects this issue may have on general practice in England.

UEMO

There was a recent conference held at BMA House which was a great success.  Details at the website.

Resolutions from the 2017 Conference of LMCs

Colleagues will have seen the Conference News published by the BMA, some may even have read it if unable to sleep. There was lengthy discussion about several of the resolutions with breakout groups to look at the best way to implement them.  It is conceivable that the views may change depending on the election on a new chairperson for GPC.   Effort is being put into having a proactive narrative, telling others what we think is needed rather than simply delineating the problems.

The official GPC news can be found soon at the usual bit of the BMA website.  This often includes information that is said to be confidential in the meetings but nevertheless works its way into the documents!

The next GPC meeting is in July, a GPCUK meeting.  I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

GPC report 16 March 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
16 March 2017

The GPC met last week.  This was a GPCUK meeting, with representatives from all four nations being present, with discussions regarding pan-UK issues.

Contract 2017/18
I know by now that you will all have seen details of the agreed contract for next year. In the context of an annual review, it is a good deal, with CQC fee reimbursement, changes to sickness expense reimbursement and a significant reduction in bureaucracy major improvements. That said, it is in no way a rescue package nor will it do anything to sustain GP in the longer term.  But then that's what the GPFV is for, innit?  That'll be a panacea, opening vistas of delight and joy.  The LMC is working with CCGs to try to ensure that money is spent where the centre intends it to be spent.

Update on GPFV
On which note, we heard in the England report that the funding is starting to make its way to the front line in places.  As usual with these national ventures, this is highly variable and local hoops to jump through are being deployed by some areas.  In East and West Sussex (and the rest of the Lmc federation) we continue to engage as a constructively critical stakeholder with the commissioning bodies.

Intermediaries legislation
We received an update on the changes with the IR35 issues.  A briefing note from Julius has already been sent out from the LMC office for practices and GPC guidance for practices is being developed. Sessional colleagues can access guidance specific to Locums at the following two links:
www.bma.org.uk/advice/employment/tax/ir35-advice-for-locums
www.bma.org.uk/advice/employment/gp-practices/gps-and-staff/a-guide-to-employment-status


GPC Reform
We had a an update of progress in the reform of GPC to try and modernise the way it works.  This has been an ongoing project and I have no doubt that there will be an update at the forthcoming LMC conference in May.  While this work is important, I feel frustrated that so much time is devoted to it within the committee meetings.  I doubt whether many of you are overly interested in its details.  I have fed back that in my humble view it would be better as a receive item.  This view has had a sympathetic reaction from numerous colleagues on GPC but by no means all.

Firearms guidance update
We received a brief oral update as significant progress has been made. Guidance can be found on the Bma website at the link below. It is worth noting that the GMC may decide to make further comments in the near future...
Firearms updated guidance (https://www.bma.org.uk/advice/employment/ethics/ethics-a-
toz/firearms)

Qof update
Discussion has started about the future of QOF.  This is currently confidential but expect changes going forward.


National committee reports
We received oral reports from the Chairs of the national committee in the UK.  The variability is interesting, as is the way that conversations with NHS senior management seem to gradually incorporate ideas from elsewhere in the UK. It's almost as if we had one national health service.  Of note in the English report for my constituents was the fact that the Capita situation may be showing the first green shoots of improvement.  Let's hope they've got decent compost.

The official GPC news can be found at the usual bit of the BMA website.

The next GPC meeting is in June though there is the annual conference for LMCs  in May which I will be attending as a member of East Sussex LMC.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

GPC Report 19 January 2017

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
19 January 2017

The GPC met this week.  As I had to miss the November meeting after one of my partners was unwell (now fully recovered I am delighted to report) this is my first report for some months (please, not too much cheering at the back).  You may recall that there are now fewer meetings generally.  This meeting was of GPC England, so slightly smaller.

Contract negotiations 2017/18
I can report that negotiations have moved on after an uncharacteristically late start. I can't report any of the details or discussion however.  I should have more info in a few weeks that I can share and discuss with you.

Update on GPFV
We heard from Lena Levy, the Policy Lead within the BMA for Health Policy, and several GPC members of work around the GPFV but, in essence, it continues to be worked on.  Nobody thinks it will save general practice but it may help us keep going while we try and persuade those holding the purse strings of the necessity of more support.

STPs
We received an update on STPs, all 44 have now been published but are often difficult to find. With that in mind the BMA have a dedicated page on the website at www.bma.org.uk/stp where you can find much information. It would be fair to say that the plans are at best a mixed bag.  I couldn't possibly comment on whether anybody including the authors think the savings anticipated in many of the plans are in any way grounded in the reality that you and I inhabit rather than an alternative and possibly drug addled universe.

MCPs
We received an oral update on how things progress. In some areas of the country, there have been exciting and possibly helpful developments.  In others, the more usual morass of confusion and lack of engagement continues unabated.  In many areas there seems to be a move towards an accountable care model.  In some of those, the aim would appear to be a salaried GP service. Quite how that fits with us maintaining our independence and role as patient advocate the deity of your choice only knows. One only has to look at what has happened to our Public Health Colleagues for an idea, I suspect. Make sure you are aware of local plans and further more are involved and willing to hold the organisers to account if you feel unable to support their work.

GPC survey update
We received a brief oral update on the results of the GPC survey which have been gradually released with much media coverage.

CQC update
There have been a variety of issues around CQC, including a consultation on how they monitor and inspect services, a change in "Intelligent monitoring" to "GP Insight" (I would note that many of us think we have considerable insight into CQC and how it works already but that is not, apparently, the point).  The CQC published its "State of Care" report (here) which showed that 87% of practices were rated good or excellent, 10% require improvement (usually around processes rather than patient care) and only 3% as inadequate.  Apparently 800,000 patients are registered with services rated inadequate for safety.  The CQC definition of safety is not always as intuitive as you might expect and I would recommend looking at "Nigel's surgery" on their website.

The official GPC news can be found at the usual bit of the BMA website.  This month it includes details of the robust response to the Prime Minister's ill-informed pronouncement on seven day opening.  Apparently this came as a surprise to the Department of Health, NHS England and even Jeremy Hunt. It also includes a section on the National Audit Office report (mis)quoted by Mrs May which makes both interesting and sobering reading.

The next GPC meeting is in March though there is a conference for English LMCs and GPC England members on 23 February entitled "Working together to sustain general practice - England" which several of the LMC's Medical Directors and I will be attending. I will report back after that.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

GPC report 15 September 2016

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
15 September 2016

The GPC met on 15 September 2016.  We started with a meeting of the GPDF, where various decisions were made and newer members of GPC were utterly confused and nonplussed.

The meeting proper was the first GPC UK meeting and unfortunately I can report very little of it for reasons of confidentiality. Which is frustrating, as ever.  What I can say is that the devolved nations are facing similar problems to us in England and solutions are proving problematic.

The new Executive team for GPC England has been announced with two new members, Dr Mark Sandford-Wood (Devon) and Dr Gavin Ralston from Birmingham.

The failure of pretty much everything and anything Capita are doing was discussed and GPC continues to take both them and NHS England to task about notes transport and everything else. The degree of incompetence in commissioning and delivery is staggering.

In the afternoon we had breakout groups to discuss a variety of topics around how general practice might be supported better and differently.

And that is all I can say I'm afraid.

The official GPC news can be found at the usual bit of the BMA website.

The next GPC meeting is in November.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

GPC Report 21 July 2016

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

21 July 2016

The GPC met on 21 July 2016.  Apologies for the delay in getting this out to you, I have been eating and drinking too much with friends in France.  There will be no such excuses for the next report. 

Chaand Nagpaul was re-elected, unopposed, as the Chair of GPC UK and the new post of GPC England.  there have been changes which I have described in previous reports.  For a reminder, check the BMA GPC pages which can be found here.

News about a list cleansing project (again) appeared in the medical press just before the meeting.  the process was apparently to be led by Capita, which I am sure will fill colleagues with a sense of confidence, although confidence may not be the appropriate word.  However there had been no discussion about the process with us and NHS England have apologised.  Any process will need to be discussed with us and we will not accept any proposals which will damage General Practice.

Subsequent to the report about this issue, a motion was passed by GPC, a relatively unusual event.  The motion was as follows, and passed unanimously:

That GPC UK notes how the NHS England commissioned service for Primary Care support in England with Capita has seriously compromised patient safety and caused significant disruption to GP surgeries already under unprecedented workload pressures, and therefore has no confidence with these arrangements.

Furthermore GPC UK insists that the plans for removing patients from practice lists, which may be illegal and discriminatory, should be abandoned and NHS England must commit to discussions with GPC England before any further list management plans are put in place. 

Furthermore, on the day of GPC a significant event came to light regarding the so-called transformation of primary care support services.  Colleagues may have seen an article in Pulse about this issue.  In essence, in some areas where SBS had been providing support (I use the term loosely) it was discovered that a backlog of clinical correspondence and results stretching back over several years remained in storage areas and had not been processed.  The correspondence includes temporary resident forms, duplicate documents or some results and communications about treatment steps.  NHS England have undertaken a clinical review to assess any high risk correspondence.  GPC is discussing a remuneration and support package for practices which are impacted by this event.

The Carr-Hill formula review, due to be implemented in April 2017 has, utterly unsurprisingly, been delayed until 2018.  I will believe it when I see it.

There was further discussion about how to respond to the decisions reached at LMC Conference recently.  These discussions are currently confidential but as ever I will supply more information when I can.

The issue of an indemnity support scheme was discussed.  Conversations with NHS England continue but the current iteration can be found here.  It is a start but not ideal.

The official GPC news can be found at the usual bit of the BMA website.

The next GPC meeting is in September, and every two months thereafter.  So a silver-lining, you will be getting fewer of these from me!

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

GPC Report 16 June 2016

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

16 June 2016

The GPC met on 16 June 2016. Apologies for the delay in getting this out to you.

The first meeting after the annual LMC Conference, there was much to discuss. However, as ever, much of the discussion is confidential. Additionally, the afternoon was taken up in part by Subcommittee meetings, though on this occasion the subcommittees were essentially continuing more focussed discussions as a result of the events and debates which had occurred in GPC.

Workload management was discussed and it evident that there is significant common ground between GPC and NHSE, at least in terms of context and a recognition of the crisis that is occurring in General practice. There was considerable discussion around how GPs can or could manage their workload with patient safety in mind, following on from discussions at LMC Conference. This limiting could take several forms and more info will be forthcoming in due course. The Primary Care Hub was discussed in this context too. These are suggested to provide additional capacity when general practice runs out of it. Discussions around he funding of them were varied. Whatever happens, the direction of travel is for these to be in our futures in some form or other. It is important that we not only influence but control those developments.

Colleagues may recall the Quality First templates and information released by GPC in January 2015 (yes, over a year ago). A new web portal providing easy access to the information, which is intended to be updated frequently has been published on the BMA website. A first look impressed me with its ease of navigation and usefulness, not something I have previously noted in iterations of the Bma website.

The rest of the meeting was confidential but covered areas such as the actions necessary following the LMC Conference, the GPFV and the continuing development of the MCP Voluntary contract, which is currently subject to purdah, so expect news shortly after the Referendum.

The next meeting is the first in a new GPC year in July, after the BMA's ARM in Belfast next week. There will be changes to how things work, with GPC UK becoming an entity which meets 2-3 times a year and GPC England meeting 4-5 times. This is part of the changes suggested in the Meldrum review which will hopefully strengthen the LMC/GPC relationship to the benefit of both and our constituents.

The official GPC news can be found at the usual bit of the BMA website.

I hope you have found this report helpful. Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

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GPC report 21 April 2016

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
21st April 2016

The GPC held its latest meeting on 21st April.

NHS England published its "General Practice: Forward View" on the morning of GPC and it formed the major part of the morning session.  It can be found on the NHSE website.   There has been significant input from GPC and work that has been ongoing has been incorporated into the document by NHSE. Nevertheless, although there is much in it which is of promise, the devil is in the detail which is apparent by its absence and the money, though seemingly a large amount, would seem to be inadequate for what is needed.  For this reason, the BMA and GPC declined to "cobadge" the document, a position at variance with that of the RCGP.  It is certainly a starting point and an acknowledgement of the crisis that exists but it is not a rescue package that would be recognisable to most GPs. GPC will engage with NHSE to thrash out the necessary details.  An email has already gone out from Chaand Nagpaul to GPs which is available on the BMA website.  As you might imagine, I have my own views on the document but I would be interested to hear your views so I can properly represent them during discussions at GPC.

The afternoon was taken up considering a report by the GPC reform task group, chaired by previous GPC chair and chair of BMA council Hamish Meldrum. You may recall an extensive and lengthy piece of work has been going on to consider reformation of GPC and how it interacts with and answers to LMCs. This work is near completion and the report will be published next week, with a commentary from the GPC executive team generated by this afternoon's debate, in time to go out with the documents associated with the forthcoming Annual Conference of LMCs. Many of the recommendations require discussion at Conference or by the wider BMA before moving forward.  Some require changes to standing orders and bylaws of the Association. However, several are in the gift of GPC and were decided on at the meeting.  Details are currently embargoed until the paper is formally published. That being the case, there may be a short addendum to my report next week with more details. If anything more illuminating is released from the centre before then, I will let you know.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.

Dr Russell Brown

GPC report 17 March 2016

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

17th March 2016

The GPC held its latest meeting on 17th of March.

This month's report is, you might notice, short. There could be several reasons for this, including fatigue, ennui, complacency or irritability. However, because the meeting this month was short, being a morning only with subcommittee meetings in the afternoon and because much of the meeting was considering matters which must currently remain confidential there is little I can say.

We were however joined by Dr A Lupo, the President of UEMO, who described how primary care was in his home country of Italy, where family doctors (independent contractors in the main) are in dispute with their government and who have recently postponed a 48 hour strike to allow negotiations to proceed. 

There was a presentation about DevoManc and how it is moving ahead. It was noticeable that there is much risk involved and that, although we were reassured that GPs are fully engaged, local GPC reps have a different view.

An update on the Urgent Prescription for General Practice campaign was given by Beth McCarron Nash.  It has apparently been quite successful, though I am unclear by what measure. It, together with the Quality First documents, are to be commended to you as they assist you in protecting yourself in various ways.

In the afternoon, the subcommittee I sit on, the Commissioning and Services Development Subcommittee, met.  Unfortunately it mostly discussed specific parts of the same issue as the morning which I am unable to report and so, like the information from the morning session, I am unable to report it. 

And that is, my friends, about all I can tell you from this month!  The next meeting will be in April, with the Annual Conference of LMCs being in May. 

To sign off, I will abuse my position to remind you of a survey being run by my organisation, Resilient GP in collaboration with both GP Survival and Londonwide LMCs, on a suggested rescue package for general practice. At the time of writing it has attracted over 2400 responses (in less than four days).  I would be delighted if you would consider completing the survey, which is not meant to provide any statistically significant output but be a cause of conversation in the corridors of influence. And as several people have asked me about the correct way to rank the questions, please consider whether the most popular song in the charts is called "the number one in the pop parade" or not.  Thank you very much! 

Here is a link:  https://www.surveymonkey.com/r/GPrescuepackage

Happy Easter or indeed any other festival you may choose to celebrate or indulge in!

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  

Dr Russell Brown

GPC report 17th December 2015

GPC Report
For East and West Sussex LMCs
Dr Russell Brown
17th December 2015

The GPC held its latest meeting on 17th of December.

As ever, much of the contract negotiations information imparted to us is confidential. However it is worth noting that the NHS £3.8 billion increase announced in the comprehensive spending review has at least a proportion coming to general practice. Details of how this will be spent are as yet unclear.  Colleagues may be aware that already £1.8 billion has been ear marked to essentially bailout acute trust deficits.

Scotland on the other hand have concluded their negotiations with QOF moving into core payments in 2017. Indeed there is much that could be admired and indeed emulated in the Scottish agreement.

A survey undertaken by the BMA on the primary-care infrastructure fund found that the situation is fraught with delays and threats even to funding approved schemes. There seems to be some difficulty with NHS England realising that they need to be funding revenue costs going forward rather than simply providing a pot of money at the outset

Indemnity costs have been considered but seemingly only superficially: £2 million has been ear marked by NHS England to help offset the costs of working in an out of hours setting this winter. It is unclear how this will be allocated presently but no doubt that will occur seamlessly and with an elegant simplicity. This obviously won't help in the longer term.

A Multi-specialty Community Provider contract advisory group has been set up. This is not to design a new GP contract but rather to try and properly formulate the environment in which MCPs will work. The presence of the GPC on this group has been moderately effective in emphasising the need for how any contracts will affect primary care to be addressed. The group does not appear to be hostile to general practice.

The atrocious comments written by Professor Steve field in the Daily Mail has resulted in a vote of no confidence by GPC. I have no doubt that, satisfying as it is, absolutely nothing will happen as a result. I understand the Royal College also posted a highly critical response. Quite how he thought this would improve the standing of CQC in the profession's eyes is beyond me.

The Special Conference of Local Medical Committees will occur on 30 January. By the time you read this motions will already have to have been submitted by the LMC. We will see what the agenda committee make of everything but I anticipate that there will be half a dozen themed debates during the day.

In the afternoon there was a presentation by Dr Arvind Madan, the new Director of Primary Care at NHS England. His previous work experience includes being a partner in the Hurley group and being an owner of WebMD. I understand his conflicts-of-interest have been appropriately managed since his appointment in the Department of Health. The presentation was apparently confidential though nothing was said that is not already in the public domain. Given there is a degree of agreement between NHS England and GPC, there was no surprise that much of what he spoke about was to do with workforce and workload. After his presentation there was a question and answer session during which the inestimable Dr Katie Bramall-Stainer from Hertfordshire was extremely clear with him exactly what we all thought. Unaccountably, he was not at the traditional post-December GPC mince pies and mulled wine event.

During the afternoon 4.2% increase in funding for general practice each year for the next few years was announced by NHS England via Pulse Today. Although this has been trumpeted as something of an improvement it actually simply allows us to standstill at current levels of funding taking inflation into account.

The current edition of the official GPC news is available at the BMA communities website here.

Other than that I hope you all have a peaceful and satisfying festive season, however you choose to celebrate it. All of us will be working for at least some of the time over the Christmas period, at a time when many of our patients will no doubt be grateful for our presents (sorry, that was appalling). I am keeping my fingers crossed for an improved 2016!

The next GPC meeting is scheduled for February.

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.
Dr Russell Brown

GPC Report 19 November 2015

GPC Report

For East and West Sussex LMCs

Dr Russell Brown

19th November 2015

The GPC held its latest meeting on 19th of November.  

The meeting began with the news of the junior doctors ballot result, which has provided their leaders with an overwhelming mandate going forwards. The unfortunate intransigence displayed by Jeremy Hunt is unhelpful. Since the meeting I understand that the Department of Health have approached ACAS to demonstrate their willingness to engage.  Whether this is with Mr Hunt's knowledge or blessing I know not. 

The meeting ended (I will return to the middle bit in a moment) with a motion being passed unanimously, with the motion being displayed below in an unusual photo from within the BMA Council Chamber. Ordinarily there are automated sentry guns monitoring use of electronic devices by GPC members, authorised to use lethal force against transgressors.

CQC fees consultation: GPs can apparently not be treated differently to any other providers, and given the Government is removing much funding from CQC as they should be self funding (as in, paid for by us) they have suggested a seven-fold increase in fees, phased in over either two or four years. Given the incompetence of the organisation, the lack of any evidence of benefit whatsoever and the huge cost the very concept of such an increase is staggering.  The DH has apparently found £15M down the back of the Departmental sofa with which to reimburse GPs, but we are not entirely sure either how they have calculated this nor whether that money is recurrent and adjustable for future increases assuming CQC continues to exist in some form. I should perhaps say that I have no idea whether there are any plans to scrap it but I live in hope. In fact I was asked by one of the patient representative observers at GPC what I thought the CQC should be replaced by. I suggested that the millions wasted would be better spent on patient care and supporting services towards excellence rather than wielding a punitive clipboard. Inspection regimes are a waste of time: if you inspect and a service is good, why bother? And if it is bad or worse, you've missed the boat and should have intervened earlier.

The Premises Infrastructure fund is proving interesting. Schemes and payments will be allowed to slip but there is an intention by NHS England to make sure the entire billion is spent but how that will equate to local procedures is uncertain.  Going forward, bids will need to be made by CCGs and not practices.  This does not seem unsensible, as any new building will need to be designed with local needs and priorities in mind.

The escalating costs of indemnity for GPs is a matter of concern not only for GPC but also NHS England and the DH, if only because it is another pressure which will likely stymie their plans if not addressed.  It is being discussed on a regular basis but whether any solutions come of it remains to be seen.

Reducing bureaucracy has taken a step forward with the announcement by Jeremy Hunt recently, as a direct result of conversation between him and GPC representatives, that hospitals will in future not ask for a further referral if a patient fails to attend an appointment. I understand there is to be a clause written into the standard hospital contract, which I am sure will be a great comfort to you all.

A meeting with my own organisation, Resilient GP, was reported. Though we were described as a pressure group when we are actually educational and supportive, the meeting was useful for both organisations and, unsurprisingly, there was to quote Chaand a "staggering amount of common ground”.

A contract working group has been set up by NHS England.  This is not to discuss and sort out the GMS/PMS contracts but to discuss a way forward for the new Multi-speciality community provider models, considering both how they can be contracted to provide services and how organisations such as General Practices might fit into them without there being too much destabilisation.  Indemnity issues have been raised again and there is recognition within the NHS that this will cause significant problems for them if not resolved.  Numerous solutions have been proposed but all come at a not inconsiderable cost.

Negotiations for the GP Contract 2016/17 have begun and almost immediately stopped again until after the details of the comprehensive spending review are formally announced.  Colleagues will be aware of the announcement on Tuesday 24 November of an extra £3.8 billion.  Interestingly, a quick back of an envelope calculation would suggest that, with the changes to National Insurance contributions being brought in, roughly £2 billion of that will head straight back to the Treasury…

A Special Conference of LMCs has been announced, likely to take place in January or February 2016.  The LMC office has already written to practices about it and more details will be shared in due course.  I am sure this will be on the agenda for LMC meetings in the next couple of months.

GPC is also looking at how to encourage more Early career GPs into medical politics, to improve the number of less experienced GPs and motivate and develop the leaders of the future.

There was a discussion about how an activity based GP contract might be made to work, after last yer’s LMC conference passed a motion proposed by Kent LMC suggesting it as a way forward.  I find it difficult to see how this can be progressed, given it doesn’t fit with the current direction of travel espoused by both the DH and Government but it is being examined.

The “official” GPC news can be found at the BMA Communities website. 

The next GPC meeting is scheduled for December. 

I hope you have found this report helpful.  Please feedback so that I can ensure my reports are useful.  Feedback is always appreciated

Dr Russell Brown